Public procurement in many countries is one of the most important factors in governance and is a priority target of reform. In many humanitarian situations however, service delivery cannot wait for procurement reform. The needs of many of the Millennium Development Goals are immediate, while procurement reform may take years to institutionalize. Under these circumstances, international organisations such as the United Nations have both implementation and capacity-building roles, often placing them in high-risk situations. This has led to the development of procurement risk assessment and management tools, designed to provide objectivity in country procurement risk monitoring and review, as well as assist capacity building. The procurement risk assessment methodology that follows uses established risk modeling to provide procurement risk ratings in 60 HIV/AIDS, Tuberculosis and Malaria programs in 26 countries, and is successfully promoting procurement strengthening within high-risk country offices.